Graves' disease - case conp 009 (ultrasonographic picture 6)

Left lobe, another longitudinal scan. We meet this pattern in every consulting hour: a moderately hypoechogenic lobe presenting discrete hypoechogenic areas - this is the most common ultrasound presentation of Hashimoto's thyroiditis. However, compared with the extralesional part, the discrete lesion contains larger and brighter hyperechogenic granules. The figures in the extralesional part might be non-specific figures, while those within the lesion might be microcalcifications. This difference was the most important suspicious sign, which suggested that this lesion would be a nodule in a pathological sense and could be even malignant. The presence of lobulated margins has limited importance in the event of Hashimoto's thyroiditis because discrete hypoechoic lesions of thyroiditis usually display this type of borders.